COLUMBUS, Ohio — Ohio has started sending notices to people enrolled in Medicaid expansion as the state prepares to enforce a new federal requirement: beginning Jan. 1, 2027, enrollees will need to complete 80 hours a month of work, community service or education. More than 760,000 working-age Ohioans with lower incomes are enrolled in Medicaid through the expansion, and many could be affected, according to figures cited by Brian O’Rourke, a policy analyst with the Health Policy Institute of Ohio. The requirement stems from H.R. 1, a federal reconciliation law passed in July 2025 that changed Medicaid eligibility rules, O’Rourke said. The Ohio Department of Medicaid has begun sending notifications ahead of implementation. Some people will be exempt, including those receiving substance use treatment, people with certain medical needs and pregnant people. But the policy may also affect older adults who are working less or have retired. O’Rourke flagged people ages 55 to 64 as a group that may face particular challenges in meeting the requirement and documenting compliance. An estimated 172,600 Ohioans could lose Medicaid coverage because of the policy over the next decade, O’Rourke said. He warned that rising uninsured rates could put added strain on health care providers, particularly rural and underserved hospitals, through increased uncompensated care and pressure on emergency departments and the safety net. State policymakers will have to manage the federal changes, O’Rourke said, adding that he hopes Ohio can find ways to offset some of their effects.